CAJ | 학술논문

目的回顾本单位开展经腰小切口肾盂成形术的围手术期并发症及手术效果,总结经验.方法总结本单位2009年1月至2014年5月进行的所有经腰小切口肾盂成形术的309例患儿(321侧肾脏)资料,分析随访结果.术前超声测定的肾盂宽度(肾盂前后径)(31.7±14.7)mm.根据同位素动态肾脏显像计算的肾小球滤过率(GFR),除对侧肾脏发育不良4例及双肾积水12例不能以对侧作为参考外,共293例计算相对分肾功能,术前患侧分肾功能平均值为(28.5±16.8)％.结果术后共有17例(17/309,5.5％)患儿发生一次或更多次尿路感染而需要静脉应用抗菌素;1例患儿发生吻合口漏,保留肾周引流3周后自行愈合;1例拔除双J管后积水增加行肾盂穿刺引流后吻合口自行恢复通畅;4侧(4/321,1.24％)因术后随访中肾积水持续增加,分肾功能持续下降,考虑吻合口狭窄而再次行肾盂成形术.术后263例(85.1％)患儿随访时间(1.93±1.35)年,共274侧肾脏,术后肾盂宽度(13.2±7.8)mm.除肾发育不良、再手术等无法以对侧为参照的患儿之外,232例随访同位素分肾功能的单侧术后患儿中,术前分肾功能大于40％共40例,术后均无分肾功能下降;术前分肾功能小于40％共192例,术后分肾功能较术前上升大于5％共134例,术后分肾功能和术前相比改变小于5％共51例,分肾功能下降大于5％共7例.获得随访的11例双侧术后患儿全部获得术后分肾功能的好转.结论经腰小切口肾盂成形术安全有效,是治疗小年龄儿童肾盂输尿管连接处梗阻的合理手术方案.
목적 회고본단위개전경요소절구신우성형술적위수술기병발증급수술효과,총결경험.방법 총결본단위2009년1월지2014년5월진행적소유경요소절구신우성형술적309례환인(321측신장)자료,분석수방결과.술전초성측정적신우관도(신우전후경)(31.7±14.7)mm.근거동위소동태신장현상계산적신소구려과솔(GFR),제대측신장발육불량4례급쌍신적수12례불능이대측작위삼고외,공293례계산상대분신공능,술전환측분신공능평균치위(28.5±16.8)％.결과 술후공유17례(17/309,5.5％)환인발생일차혹경다차뇨로감염이수요정맥응용항균소;1례환인발생문합구루,보류신주인류3주후자행유합;1례발제쌍J관후적수증가행신우천자인류후문합구자행회복통창;4측(4/321,1.24％)인술후수방중신적수지속증가,분신공능지속하강,고필문합구협착이재차행신우성형술.술후263례(85.1％)환인수방시간(1.93±1.35)년,공274측신장,술후신우관도(13.2±7.8)mm.제신발육불량、재수술등무법이대측위삼조적환인지외,232례수방동위소분신공능적단측술후환인중,술전분신공능대우40％공40례,술후균무분신공능하강;술전분신공능소우40％공192례,술후분신공능교술전상승대우5％공134례,술후분신공능화술전상비개변소우5％공51례,분신공능하강대우5％공7례.획득수방적11례쌍측술후환인전부획득술후분신공능적호전.결론 경요소절구신우성형술안전유효,시치료소년령인동신우수뇨관련접처경조적합리수술방안.
Objective To explore the perioperative complications and long-term outcomes of pyeloplasty via a miniflank incision.Methods Retrospective analyses were conducted for all clinical data of 309 patients (321 kidneys) undergoing pyeloplasty via a miniflank incision during January 2009 and May 2014.The preoperative ultrasonic pelvis width (anteroposterior diameter,APD) was 31.7 ± 14.7 mm.Preoperative average spilt renal function was calculated according to isotope scintigraphy.Except for contralateral kidney dysplasia (n =4) and bilateral cases (n =12),293 cases had an average value of renal function at 28.5 ± 16.8％.Results And 17/309 eases (5.5％) suffered urinary tract infections requiring intravenous antibiotics.One case of anastomotic leakage healed after a 3-week perirenal drainage.Four patients (4 sides,4/321,1.24％) underwent re-operation of pyeloplasty because of anastomotic obstruction with increasing hydronephrosis and worsening renal function during postoperative follow-ups.And 263 cases (85.1％) had a mean follow up period of 1.93 ± 1.35 years.Pelvis width was 13.2 ± 7.8 mm for a total of 274 kidneys.Except for kidney dysplasia and reoperative cases,232 cases received isotope scintigraphy for kidney function after operation.During the follow-ups,40 cases with over 40％ of split renal function pre-operation showed no decline.In 192 cases with preoperative renal function under 40％,51 cases had changes in split renal function of under 5％ and 134 cases had split renal function increases of over 5％.However,split renal function decreased over 5％ in 7 cases.And 11 patients with bilateral hydronephrosis improved in renal function during the follow-ups.Conclusions Pyeloplasty via a miniflank incision is both safe and effective in the treatment of younger children with ureteropelvic junction obstruction.